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The following clinical pointers were analysed:(a)rate of disease progression;(b)symmetry of parkinsonian symptoms and signs;(c)occurrence of resting tremor during the first three years from onset.In addition,all patients underwent(d)acute and chronic challenge with dopaminergic drugs; (e)cardiovascular reflex autonomic function tests;(f)high field MRI.Rapid progression of disease was seen in 45%of patients,onset was symmetric in 45%of patients,onset was symmetric in 25%,tremor was absent at onset in 70%,response to dopaminergic drug challenges was inadequate in 40%, abnormal,cardiovascular reflexes occurred in 50%,and some abnormal MRI finding occurred in 35%of cases.The sensitivity and specificity of the individual pointers considered to predict fully symptomatic MSA varied considerably,and no single item could predict whether patients presenting with just parkinsonian signs went on during the two year follow up period to develop fully symptomatic MSA.Instead,the number of abnormalities offered a predictive value for the clinical prognosis of these parkinsonian patients. |
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autonomic cardiovascular reflexes
autonomic dysfunction
L-dopa
MRI
MRI,abnormal
multiple system atrophy
neurologic disease,diagnoses of
neurologic signs
Parkinson disease,differential diagnosis of
Parkinson disease,L-dopa nonresponsive
Parkinson disease,rapid progression
Parkinson disease,treatment of
Parkinson disease,tremor,absence of
Parkinsonism multiple-system atrophy
Parkinsonism syndrome
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